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Date " - l -,Y.s" • • <br /> PuCAt Works Permit• <br /> Application For BiEg Dept+ �S�/SO rPd _ <br /> PUBLIC WORKS PERMIT PubToleFeaFee s <br /> Less ApO��Fee Pa�A § <br /> Print or Type Only B"a^�a°°° s <br /> � ' �� <br /> � ��G� % � ,(c. ' �-t � y0 G, �J��n�4�� ��c Ll�t l<ti,c� Ct/�i �SS-/2aS <br /> Owner Mailing Address Cdy Zip Phone <br /> ��i�v �,��e:�;�/=c.eta/ L�� r�/_ �ir� J��`'l. `lI� y�z �..,����rL� lG�'v i6''9�- 1�r3-Y7 <br /> Applicant � Mailing Address City Zip Phone <br /> i <br /> Describe Proposed Work ��/ k � 2 Ci�«c���.i, � . <br /> •ZC �•!"��' �/ !. � ,'R., c.. /�[i._'G.�l�rr'-CJ <br /> ��' Y �.1 nfti.l t't,(— l . <br /> - > � �. W <br /> Pro�ect Addrosr,�if known) � �u �' / t� .C�-L i,P C�C�' ��:��'[ � <br /> Atlach lour(4)c.ipies of plans for proposed work� Draw lo scale and note the lollowing as applicable: � <br /> • Propt�ty Lines • Centerline of sireel � <br /> • Outline ano dimensions ol all exis�ing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed 9rading changes <br /> • Existing and propcSeA utilities • Show measurements � <br /> ��� <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CJNDITIONS <br /> 1. All calls for inspection snnll be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be perlormed in acwrdance with ih�s permit and current Ciry ol Everett Design and Construction <br /> Standards and Specilicalions. <br /> 3. Call Location Underground Service 48 hrs, belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �l/ ���y�'" /� � l-LG�-�_s ��,�/�/,'�� O <br /> �{� / <br /> �J-�/'`i�%Frr� J � <br /> �r��/ y/� �_� v/ <br /> / / � <br /> , � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hareby agrees to hold and save harm- <br /> les, the City of Everett irom any and all claims lor damages. costs, <br /> expenses, or causes ot adion ihat may arise because ol installation <br /> and maintenance of Ihe improvement or other right-of-way use hereto <br /> Approved tor Conslrudion Date app;ied for and lurther agrees to remove same upon notice Irom the <br /> City and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Appwved as Conslructed Signalure of Applicant Date <br /> even•tl PUBLIC WORKS DEPHRTMENT WORK AIITHnR12ED 8V THIS PERMIi MUST DE STAFTED W!THIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSU[D AND THEREAFTER IS TO <br /> Everell,WA 98201 8[ DILIGENI�LY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone: 259�BB15 CANCELLED BY TNE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATIO� <br />